Contemporary management of children with atrial septal defects: a focus on transcatheter closure

Atrial septal defects that result in right atrial and ventricular volume overload should be closed if diagnosed in children and adolescents. With closure of the atrial septal defect, the left-to-right shunt is eliminated e.g. the volume loading of the right heart, the excessive pulmonary blood flow and the total cardiac work load are reduced. The possibility of future arrhythmic events is lessened and paradoxical emboli across the septum eliminated. The first intracardiac surgical repair of a congenital lesion was a defect in the atrial septum nearly 50 years ago. Surgical closure remains a valuable, although viable technique. Recently percutaneous transcatheter techniques are now available. The conventional approach is via a median sternotomy incision but is associated with pain, risk of wound infection, postoperative immobilization and a permanent scar. It has been suggested that alternative approaches such as surgical repair using mini-sternotomy or lateral thoracotomy incisions yield similar results to the conventional surgical technique and are associated with fewer adverse effects. Transcatheter closure has developed over the last two decades and has evolved into a well tolerated, efficient and cost effective method with minimal discomfort for the patients. Complete closure rates are high and this approach has become a viable option for ASD management.